Abstract P4-11-01: Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy

Introduction:

Anxiety is a common symptom in patients with newly diagnosed cancer. Patients with high levels of anxiety have been shown to choose more invasive surgeries in various cancer settings. Rates of contralateral prophylactic mastectomy in the adjuvant setting remain high, despite offering no survival advantage. In the neoadjuvant setting, patients have more time for decisions regarding final surgery. If anxiety is playing a role in their decisions, this could be addressed while on neoadjuvant therapy (NAT). However, the impact of anxiety at initial diagnosis on surgical decision making in this setting has not yet been studied.

Methods:

Data collected from a prospective institutional database of breast cancer patients treated with NAT at the British Columbia Cancer Agency (BCCA) were utilized to identify all patients. Information was extracted from this database with regards to patient and tumour characteristics, initial surgical plan, and final surgery performed. This was cross referenced with patient self-reported anxiety, which was extracted from the Edmonton Symptom Assessment System (ESAS) and the Psychosocial Screen for Cancer (PSSCAN) forms administered at initial consultation. Patients were assigned a score of 0 to 3 based on their answers to the ESAS anxiety scale and the PSSCAN anxiety questions, and whether or not they had any concerns related to their care. Patients were excluded if they had bilateral breast cancer, BRCA mutation or referral to the Hereditary Cancer Program, did not receive NAT or undergo breast surgery, or did not complete the forms. Fisher's exact tests were applied for statistical analysis.

Results:

From 2012-2016, 361 potential patients were identified for this study. A total of 203 patients met eligibility criteria. 93 patients (46%) had low anxiety (score 0 or 1) and 110 patients (54%) had high anxiety (score 2 or 3). Patients with high self-reported anxiety at initial consultation were significantly more likely to undergo bilateral mastectomy for unilateral disease and mastectomy for breast conserving surgery (BCS) eligible disease than those with low self-reported anxiety at initial consultation (37.3% VS 18.3%; p=0.003). No significant differences in treatment times (time interval between biopsy to chemotherapy, chemotherapy to surgery, and surgery to radiation) or investigations were identified when comparing high and low anxiety patients.

Anxiety level and type of surgery performedType of SurgeryAnxiety Level  Low (n=93)High (n=110) Bilateral Mastectomy and Mastectomy for BCS eligible disease17 (18.3%)41 (37.3%) BCS and Mastectomy for non-BCS eligible disease76 (81.7%)69 (62.7%)    p = 0.0031

Conclusion:

High anxiety scores lead to a 19% increase in bilateral mastectomies in patients without bilateral disease and mastectomies in patients eligible for BCS compared to patients with low anxiety (p = 0.003). These findings suggest that self-reported anxiety levels can inform and assist physicians to identify patients who are more likely to undergo aggressive surgery and may need further counselling and support services. Future work should examine the effects of counselling intervention in patients with high anxiety on surgical decisions.

Citation Format: Li H, Cheung W, Myers P, McKevitt E, Willemsma K, Deruchie Tan A, Chia S, Simmons C. Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-01.

Evaluation of Epoetin Alpha (rHuEPO) and Darbepoetin Alpha (DARB) on Human Burst-colony Formation (BFU-E) in Culture

The erythropoietic effect of recombinant human erythropoietin, epoetin alpha (rHuEPO), in promoting the growth of erythroid burst-forming units (BFU-E) was compared with darbepoetin alpha (DARB), a rHuEPO analogue obtained by site-directed mutagenesis. Human bone marrow cells derived from healthy donors were cultured with different concentrations of rHuEPO or DARB for 12-21 days and BFU-E were counted using an inverted microscope. The EC50 of rHuEPO was about 10-fold lower than DARB and the size of the colonies was significantly larger in rHuEPO-containing cultures using comparable concentrations. The maximum number of colonies obtained in some rHuEPO-containing cultures was also higher than for DARB. The number of colonies in DARB-containing cultures was increased, in part, by the addition of low concentrations of rHuEPO, but not by DARB, even at high concentrations. We conclude that DARB is not as effective as rHuEPO in supporting the in vitro growth of human BFU-E.

Recent trends in breast, cervical, and colorectal cancer screening test utilization in Canada, using self-reported data from 2008 and 2012

In Canada, self-reported data from the Canadian Community Health Survey 2008 and 2012 provide an opportunity to examine overall utilization of breast, cervical, and colorectal cancer screening tests for both programmatic and opportunistic screening. Among women 50-74 years of age, utilization of screening mammography was stable (62.0% in 2008 and 63.0% in 2012). Pap test utilization for women 25-69 years of age remained high and stable across Canada in 2008 and 2012 (78.9% in 2012). The percentage of individuals 50-74 years of age who reporting having at least 1 fecal test within the preceding 2 years increased in 2012 (to 23.0% from 16.9% in 2008), but remains low. Stable rates of screening mammography utilization (about 30%) were reported in 2008 and 2012 among women 40-49 years of age, a group for which population-based screening is not recommended. Although declining over time, cervical cancer screening rates were high for women less than 25 years of age (for whom screening is not recommended). Interestingly, an increased percentage of women 70-74 years of age reported having a Pap test. In 2012, a smaller percentage of women 50-69 years of age reported having no screening test (5.9% vs. 8.5% in 2008), and more women reported having the three types of cancer screening tests (19.0% vs. 13.2%). Efforts to encourage use of screening within the recommended average-risk age groups are needed, and education for stakeholders about the possible harms of screening outside those age groups has to continue.

Odontogenic facial swelling of unknown origin

BACKGROUND

Current radiography techniques have limitations in detecting subtle odontogenic anomalies or defects that can lead to dentoalveolar and facial infections. This report examines the application of micro-CT imaging on two extracted teeth to enable detailed visualization of subtle odontogenic defects that had given rise to facial swelling.

METHODS

Two extracted non-carious mandibular left primary canine teeth (73) associated with odontogenic infections were selected from two patients, and an intact contralateral tooth (83) from one of the patients was used as a control. All three teeth were subjected to three-dimensional micro-CT imaging at a resolution of 20 μm.

RESULTS

Tooth 73 from the first case displayed dentine pores (channels) that established communication between the pulp chamber and the exposed dentine surface. In comparison, tooth 73 from the second case had a major vertical crack extending from the external enamel surface into the pulp chamber. The control tooth did not display any anomalies or major cracks.

CONCLUSIONS

The scope of micro-CT imaging can be extended from current in vitro applications to establish post-extraction diagnosis of subtle odontogenic defects, in a manner similar to deriving histopathological diagnoses in extracted teeth. Ongoing technological advancements hold the promise for more widespread translatory applications.

25 year survival outcomes for squamous cell carcinomas of the head and neck: population-based outcomes from a Canadian province

OBJECTIVES

Long term outcomes of patients with head and neck cancer (HNC) are rarely reported, but of potential benefit to clinicians and researchers. Squamous cell carcinomas (SCC) of the head and neck represent a heterogeneous group of cancers. The purpose of this population based study is to describe primary site specific, long term outcomes of HNC.

METHODS

All patients from a Canadian province diagnosed between 1986 and 1990 with SCC of the oral cavity, pharynx, and larynx were identified. Chart review and patient data were abstracted through the provincial cancer registry database. Survival analysis was performed with Kaplan Meier methods, while differences in survival between groups were assessed with log-rank tests. Multivariable analysis was performed using Cox-regression.

RESULTS

1657 patients were analyzed during the study period. Almost half (50.9%) of the cases were advanced stage (stage III IV) at presentation. Two, 5, 15 & 25year overall survival (OS) and HNC specific survival for all the patients were 64%, 46%, 21%, 11% and 74%, 63%, 53% & 49%, respectively. OS and HNC-specific mortality were statistically inferior among men, older age at diagnosis, advanced stages of disease, and was primary cancer site specific, with worse survival in oropharyngeal & hypopharyngeal sites, p<0.001.

CONCLUSIONS

Survival rates vary by primary HNC site, and the overall survival & HNC specific survival differ over this long follow up assessment. Head and neck cancer specific death is most common in the first five years, and is subsequently dominated by competing causes of mortality. These results are useful as a reference tool for clinicians, researchers, and trainees.

New chart review data validate administrative data-based indicator for guideline-recommended treatment of locally advanced non-small-cell lung cancer and shed light on reasons for non-referral and non-treatment

The 2012 Cancer System Performance Report is the 4th annual report on the Canadian cancer control system produced by the System Performance initiative at the Canadian Partnership Against Cancer, in collaboration with its provincial and national partners. [...]

Irreversible electroporation for unresectable hepatocellular carcinoma: initial experience and review of safety and outcomes

The aims of this study were to evaluate the safety, feasibility and tumour response of _irreversible electroporation, a non-thermal ablation technique, for the treatment of unresectable hepatocellular carcinoma. The endpoints were safety and local treatment efficacy. Patients with unresectable tumours and tumours not amenable for radiofrequency _ablation because of their vicinity to organs vulnerable to thermal damage such as the bowel or because they were close to large blood vessels that would limit efficacy of ablation due to the heat sink effect were treated with irreversible electroporation using percutaneous _ultrasound and/or computed tomography guided electrode placement between November 2008 and _December 2009. Early, late, minor and major complications were recorded. Tumour response was determined on triphasic helical computed tomography follow-up at one month, then every three months post-procedure. Eleven patients received IRE therapy to 18 HCC lesions (Mean diameter 2.44 ± 0.99 cm; range 1.0-6.1 cm) with five patients having more than one treated HCC. Mean follow-up was 18 months (range 14-24 months). Six patients required repeat treatments for local residual or recurrent disease; two of these also had IRE for distant intrahepatic recurrence. No serious complications were observed despite seven lesions lying adjacent to important structures or organs. Four patients developed transient urinary retention and seven developed transient local post-procedure pain. After IRE therapy, 13 (72%) lesions were completely ablated with 93% success for lesions ≤ 3 cm (13/14). The local recurrence-free period was 18 ± 4 months and the distance recurrence free period was 14 ± 6 months. These preliminary results suggest that IRE is a safe and feasible technique for local ablation of HCC, particularly for lesions less than 3 cm. No major complications were encountered during this study even for tumours close to essential structures or organs.

A retrospective chart review validates indicator results and provides insight into reasons for non-concordance with evidence-based guidelines

As part of the system performance initiative of the Canadian Partnership Against Cancer, indicators measuring treatment practice patterns across the country relative to evidence-based guidelines were first published in 2010 and are updated annually. Among the treatment indicators examined is the percentage of resected stage ii and iii rectal cancer patients receiving neoadjuvant (preoperative) radiation therapy (RT), the treatment approach recommended for locally advanced rectal cancer